Project Summary/Abstract Forty-six percent of employers offer insurance coverage for telemedicine services today, up from 28% in 2013. This is a significant shift from historical patterns where telemedicine care delivery was largely promoted in underserved inner city and rural areas in order to improve access to specialty care. With the expansion of the internet, faster connection speeds, improved bandwidth, and greater use of mobile devices, more patients have the means to access providers via telemedicine from their home, potentially improving access and convenience more broadly. Understanding how video telemedicine, when made widely accessible, changes the patient-provider interface is critical to understanding how to more efficiently and effectively deliver care. Two barriers to the expansion of telemedicine on a broad basis have been 1) the lack of a telemedicine platform through which patients can access a wide range of physicians from their own home and 2) the lack of insurance coverage when provider consultation is sought. These barriers have recently been overcome by one of the largest US health insurers, which offers a direct-to-consumer, video telemedicine tool. The tool gives 19 million adults around-the-clock access to physicians via computer or mobile device, improving convenience and removing access barriers that arise from travel time, the need to leave work, or the need for child care. This form of telemedicine is distinct from disease-specific programs and from electronic telemedicine visits (?e-visits?) studied previously. Patient response to this form of direct-to-consumer, video telemedicine is not well understood. Our multi-year study will take advantage of a natural experiment provided by the insurer's introduction of the virtual visits through a direct-to-consumer telemedicine tool to study the effect of the tool on 1) patient access to care, 2) quality of care, and 3) utilization and expenditures for common conditions across alternative sources of care (retail clinics, primary care offices, emergency room). The study is innovative in its analysis of a unique natural experiment that created differential financial incentives for video telemedicine use among insured adults, its use of unique data, the size of the intervention group (19 million adult enrollees), its longitudinal design, and collaboration with a large US private insurer. Findings from this study will inform private insurer policies, state telemedicine laws and regulations, as well as Medicare and Medicaid coverage policy where coverage is geographically limited or restricted to a narrow set of services,